Johansen Ingrid H, Mellesdal Liv, Jørgensen Hugo A, Hunskaar Steinar
National Centre for Emergency Primary Health Care, Uni Health, Bergen, Norway.
Nord J Psychiatry. 2012 Feb;66(1):40-8. doi: 10.3109/08039488.2011.598554. Epub 2011 Aug 10.
In Norway, general practitioners serve as gatekeepers for specialist psychiatric care. Out-of-hours primary healthcare (i.e. casualty clinics) is responsible for the major part of acute psychiatric referrals. There are concerns regarding regular general practitioners' (rGPs') role in emergency psychiatric care of their enlisted patients. Also, the quality of casualty clinics' care and their gatekeeper function are questioned.
To investigate differences between acute admissions to a psychiatric hospital from casualty clinics, rGPs, specialist psychiatric services and other specialist services regarding characteristics of patients and circumstances of the referrals.
A prospective observational study. In the period of 1 May 2005 to 30 April 2008, anonymous information was recorded for all consecutive admissions (n = 5317) to the psychiatric acute unit (PAU) at a psychiatric hospital serving 400,000 inhabitants. The recorded information was: referring agent, circumstances of the referral, patient characteristics, and assessments by the receiving psychiatric resident and the therapist in charge of treatment at the PAU.
There were only small differences between patients referred to PAU from casualty clinics, rGPs, specialist psychiatric services and other specialist services. The referrals from the different referring agents seemed equally well founded. However, the casualty clinics used more police assistance and coercion, and legal basis for admissions was more frequently converted than for other referring agents.
Casualty clinics seem to function adequately as gatekeepers. The high proportion of casualty clinic referrals with converted legal basis might indicate unnecessary use of coercion.
在挪威，全科医生是专科精神科护理的把关人。非工作时间的初级医疗保健机构（即急诊诊所）负责大部分急性精神科转诊。人们对普通全科医生（rGPs）在其登记患者的紧急精神科护理中的作用表示担忧。此外，急诊诊所的护理质量及其把关功能也受到质疑。
调查从急诊诊所、rGPs、专科精神科服务机构和其他专科服务机构转诊至精神病院的急性入院患者在患者特征和转诊情况方面的差异。
一项前瞻性观察研究。在2005年5月1日至2008年4月30日期间，记录了一家为40万居民服务的精神病院精神科急性病房（PAU）所有连续入院患者（n = 5317）的匿名信息。记录的信息包括：转诊机构、转诊情况、患者特征，以及接收精神科住院医生和PAU负责治疗的治疗师的评估。
从急诊诊所、rGPs、专科精神科服务机构和其他专科服务机构转诊至PAU的患者之间只有细微差异。来自不同转诊机构的转诊似乎依据相当。然而，急诊诊所更多地使用警方协助和强制手段，与其他转诊机构相比，入院的法律依据被更改的频率更高。
急诊诊所似乎能充分发挥把关人的作用。具有更改后法律依据的急诊诊所转诊比例较高，这可能表明存在不必要的强制手段使用情况。
